Q&A: Understanding secondary headache disorder

Dear Mayo Clinic: How can you tell when a headache requires additional diagnostic testing?

A: Headaches come with a wide range of accompanying symptoms and severity. Most often, they are due to a primary headache disorder, such as a tension-type headache or migraine. In older adults, most headaches are still primary in nature.

However, older adults are more likely than their younger counterparts to experience a secondary headache disorder. A secondary headache is when the headache pain is a symptom of an underlying problem or condition. An “ice cream headache” is an example of a secondary headache that isn’t a worrisome cause. However, some secondary headaches may be warning signs of something more serious, such as an aneurysm or tumor.

Certain “red flag” characteristics are more worrisome and should be discussed with your health care provider. Represented by the acronym “SNOOP4,” these headache characteristics are:

Headaches are accompanied by signs and symptoms, such as weakness, numbness, trouble walking, confusion, seizures, or difficulty staying alert or maintaining consciousness.

Onset

They begin suddenly or abruptly, such as a severe headache that peaks within one to two minutes (also known as a “thunderclap headache”).

Older age

They begin to occur or progress after age 50.

Pattern change

There are changes in frequency, severity or character that differ from previously experienced headaches. For example, if you normally have mild visual symptoms with your headaches, a dramatic increase in visual symptoms may be concerning.

Progressive

The attacks worsen over time.

Precipitated by exertion

Headaches occurs with a cough, sexual activity, bowel movements, bearing down or other activity.

Positional worsening

They change in severity, depending on whether you’re upright or lying down.